Nutritional status of Four Distinct Particularly Vulnerable Tribal Groups Adult Females of Chhattisgarh, India using Mid-Upper Arm Circumference

Abstract

Introduction. Malnourishment plays a substantial role in the world's mortality rates, especially among old and children. Even though malnutrition mortality among adult women dropped greatly between 1990 and 2021, maternal health is still a matter of concern. The purpose of this study is to evaluate the nutritional status among adults belonging to four Particularly Vulnerable Tribal Groups (PVTGs) of Chhattisgarh, India, through Mid-Upper Arm Circumference (MUAC) as a major indicator.

Materials and Methods. The cross-sectional survey was carried out from 2020 to 2024 in 272 adult women belonging to the Abujhmadia, Baiga, Birhor, and Hill Korwa tribes. Prior to data collection, participant consent was received with the measurement of Mid-Upper Arm Circumference at the middle of the upper arm. Descriptive statistics and ANOVA tests were used for data analysis in comparing the mean Mid-Upper Arm Circumference in different age groups.

Results. The results indicated that the Abujhmadia cluster had the greatest prevalence of undernutrition at 82.7%, followed by Hill Korwa (77.3%), Baiga (75.5%), and Birhor (60%). Important age-specific patterns in the prevalence of undernutrition were observed, especially within the 18-27 age groups.

Discussion. Mid-upper arm circumference is a valid and affordable tool for determining nutritional status in low-resource environments. It brings to light the nutritional plight of Particularly Vulnerable Tribal Groups (PVTGs), necessitating the implementation of specific public health interventions to tackle these problems.

Conclusion. The findings of the study highlight the need for immediate nutritional intervention programs for PVTGs in Chhattisgarh. Identification of their special nutritional needs can considerably enhance health outcomes and mitigate malnutrition in these vulnerable groups.

Acknowledgments. The authors appreciate the time taken by the female participants for participating in this study. We also appreciate the administrative help from the community workers, panchayat staff of all four communities. Authors were also thankful to University administration for their continuous motivation and promotion of research.

References

Banik S.D. Nutritional status of adult men from the Oraon tribe in Ranchi district of Jharkhand, India. Malaysian Journal of Nutrition, 2008, 14, pp. 91–99. 

Bhan N., Rao K.D., Kachwaha S. Health inequalities research in India: a review of trends and themes in the literature since the 1990s. International journal for equity in health, 2016, 15 (1), p. 166. https://doi.org/10.1186/s12939-016-0457-y

Bisai S., Bose K. Undernutrition in the Kora Mudi
tribal population, West Bengal, India: A comparison of body mass index and mid-upper-arm circumference. Food
and Nutrition Bulletine, 2009, 30, pp. 63-67. https://doi.org/10.1177/156482650903000106

Bose K., Das S. Muac- based nutritional status of 2-5 years old Bauri caste preschool children of Purulia, West Bengal.  Journal of Indian Anthropological Society, 2010, 45, pp. 301-306.

Briend A., Garenne M., Maire B., Fontaine O., Dieng K. Nutritional status, age and survival: the muscle mass hypothesis. European journal of clinical nutrition, 1989, 43 (10), pp. 715-726.

Casadei K, Kiel J. Anthropometric Measurement. (Updated 2022 Sep 26). In: StatPearls (Internet). Treasure Island (FL): Stat Pearls Publishing, 2025; Available at: https://www.ncbi.nlm.nih.gov/books/NBK537315/ Accessed 20.07.2025.

Census of India. Data of Bilaspur Teshil, 2011a. Available at https://www.censusindia.co.in/subdistrict/kota-tehsil-bilaspur-chhattisgarh-329

Census of India. Office of the Directorate of Census Operation, Government of India. Odisha. Available at: India - Census of India 2011b - Administrative Atlas - Odisha - Volume II https://odisha.census.gov.in/Census.html. Accessed 20.07.2025.

Chakraborty R., Bose K., Bisai S. Mid-upper arm circumference as a measure of nutritional status among adult Bengalee male slum dwellers of Kolkata, India: Relationship with self-reported morbidity. Anthropologischer Anzeiger, 2009, 67, pp. 129–37. https://doi.org/10.1127/0003-5548/2009/0017

Collins S. Using middle upper arm circumference to assess severe adult malnutrition during famine. JAMA, 1996, 276 (5), pp. 391-395. https://doi.org/1996.03540050051023

Collins S., Duffield A., Myatt M. Assessment of nutritional status of adults in emergency-affected populations, RNIS Supplement ACCN (August), 2000, Available at: www.unscn.org/layout/modules/resources/files/AdultsSup.pdf. Accessed 20.07.2025.

Das A., Saimala G., Reddy N., Mishra P., Giri R., et al. Mid-upper arm circumference as a substitute of the body mass index for assessment of nutritional status among adult and adolescent females: learning from an impoverished Indian state. Public Health, 2020, 179, pp. 68-75. https://doi.org/10.1016/j.puhe.2019.09.010

Das S., Bose K. Nutritional assessment by mid-upper arm circumference of santal adults of Purulia, West Bengal, India. Collegium Antropologicum, 2012, 36 (2), pp. 581-584.

de Onís M., Monteiro C., Akré J., Glugston G. The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth. Bulletin of the World Health Organization, 1993, 71 (6), pp. 703-712.

Dutta M., Selvamani Y., Singh P., Prashad L. The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16). Epidemiology and health, 2019, 41, e2019050. https://doi.org/10.4178/epih.e2019050

Ferro-Luzzi A., Jame W.P. Adult malnutrition: simple assessment techniques for use in emergencies. The British Journal of Nutrition, 1996, 75 (1), pp. 3-10. https://doi.org/10.1079/bjn19960105

Ghosh R., Bharati P. Nutritional status of adults among Munda and Pod populations in a peri urban area of Kolkata City, India. Asia-Pacific Journal of Public Health, 2006, 18 (2), pp. 12-20. https://doi.org/10.1177/10105395060180020301

Global Nutrition Report. The burden of malnutrition at a glance. 2022. Available at: https://globalnutritionreport.org/resources/nutrition-
profiles/asia/southern-asia/india/ Accessed 20.07.2025.

Himes JH. Challenges of accurately measuring and using BMI and other indicators of obesity in children. Pediatrics, 2009, 124, 1, pp. 3-22. https://doi.org/10.1542/peds.2008-3586d

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2021, India, 2019-21: Uttar Pradesh. Mumbai: IIPS.

James W.P.T., Mascie-Taylor C.G.N., Norgan N.G., Bristrian B.R., Shetty P. et al. The value of arm circumference measurements in assessing chronic energy deficiency in Third World adults. European Journal of Clinical Nutrition, 1994, 48, pp. 883-894.

Kennedy E.T. Evidence for nutritional benefits in prolonging wellness. The American Journal of Clinical Nutrition, 2006, 83 (2), pp. 410-414. https://doi.org/10.1093/ajcn/83.2.410S

Kok P., Seidell J., Meinders AE. The value and limitations of the body mass index (BMI) in the assessment of the health risks of overweight and obesity.  Nederlands Tijdschrift voor Geneeskunde, 2004, 148: 2379-2382.

Kumar S., Singh R. Nutritional status and dietary practices among tribal populations: A review. Journal of Tribal Health, 2021, 18 (2), pp. 45-52.

Lohman T.G., Roche A.F., Martorell R. Anthropometric standardization reference manual. Human Kinetics Books, 1988.

Luma HN., Eloumou S., Mboligong FN., Temfack E., Donfack OT., et al. Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study. BMC Research Notes, 2017, 10, p. 238. https://doi.org/10.1186/s13104-017-2592-y

Maalouf-Manasseh Z., Remancus S., Milner E., Fenlason L., Quick T., et al. Global mid-upper arm circumference cut-offs for adults: a call to action. Public Health Nutrition, 2020, 23 (17), pp. 3114-3115. https://doi.org/10.1017/S1368980020000385

National Family Health Survey (NFHS-4) 2015-16. International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS, 2017, Accessed 05.07.2025.

Philpott D.C., Belchior-Bellino V., Ververs M. Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees. Public Health Nutrition, 2021, 24 (15), pp. 4777-4785. https://doi.org/10.1017/S1368980021002913

Pradhan D., Singh H., Joshi S. The efficacy of Mid-Upper Arm Circumference in assessing malnutrition in rural communities. Indian Journal of Community Health, 2020, 32 (3), pp. 500-506.

Rothman KJ. BMI-related errors in the measurement of obesity. International Journal of Obesity, 2008, 32 (3), pp. 56-59.

Saka M., Türker P., Ercan A., Kiziltan G., Baş M. Is neck circumference measurement an indicator for abdominal obesity? A pilot study on Turkish Adults. African health sciences, 2014, 14 (3), pp. 570-575. https://doi.org/10.4314/ahs.v14i3.11

Sánchez-García S., García-Peña C., Duque-López MX., Juárez-Cedillo T., Cortés-Núñez AR., et al. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health, 2007, 7, p. 2. https://doi.org/10.1186/1471-2458-7-2

Sethi V., Parhi R.N., Dar S., Agrawal S. Feasibility and diagnostic accuracy of using armband mid-upper arm circumference as a simple screening tool for maternal wasting in rural India. Rural Remote Health, 2017, 17, pp. 4221. https://doi.org/10.22605/RRH4221

Standardized Monitoring and Assessment of Relief and Transitions (SMART) Measuring Mortality, Nutritional Status, and Food Security in Crisis Situations: SMART Methodology. Available at: http://www.conflict.lshtm.ac.uk/media/SMART_ Manual_v1_FINAL.pdf . Accessed 20.07.2025.

Sultana T, Karim M.N., Ahmed T, Hossain M.I. Assessment of Under Nutrition of Bangladeshi Adults Using Anthropometry: Can Body Mass Index Be Replaced by Mid-Upper-Arm-Circumference?. PloS One, 2015, 10 (4), e0121456. https://doi.org/10.1371/journal.pone.0121456

Tang A. M., Chung M., Dong K. R., Bahwere  P., Bose K., et al. Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women). Public health nutrition, 2020, 23 (17), pp. 3104–3113. https://doi.org/10.1017/S1368980020000397

Touitou Y., Portaluppi F., Smolensky M. H., Rensing L. Ethical principles and standards for the conduct of human and animal biological rhythm research. Chronobiology International, 2004, 21 (1), pp. 161–170. https://doi.org/10.1081/cbi-120030045

Tripathi S. Birhor and their culture: an ethnographic account of Particularly Vulnerable Tribal Group of Chhattisgarh. Jal Jangal Jameen, 2017, pp. 127-150.

United Nations Children's Fund (UNICEF) Nourishing Wombs: Delivering an Integrated Package of Maternal Nutrition Interventions in Andhra Pradesh and Telangana (India) Nutrition Reports, Issue 10, UNICEF, New Delhi, India. 2017. Accessed 20.07.2025.

United Nations Children's Fund (UNICEF). Available from: https://www.supply.unicef.org/unicef_b2c/app/displayApp/cpgsize=5 and layout=7.0.12_1_66_68_115_2&uiarea =2&carea=50D129C26B9F08F2E10000009E710FC1&cpgnum=3)/.do?rf=y . Accessed 20.07.2025.

Van Tonder E., Mace L., Steenkamp L., Tydeman-Edwards R., Gerber K., et al. Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition. South African Journal of Clinical Nutrition, 2019, 32 (4), pp. 93-98.  https://doi.org/10.1080/ 16070658.2018.1484622.

von Grebmer K., Bernstein W.J., Geza M., Ndlovu M., Wiemers L., et al. Global Hunger Index: The Power of Youth in Shaping Food Systems. Bonn: Welthungerhilfe (WHH), 2023.

WHO. Fact sheets (Malnutrition) 2024. https://www.who.int/news-room/fact-sheets/detail/malnutrition#:~:text=In%202022%2C%20approximately%2.... Accessed 20.07.2025.

WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization technical report series, 1995, 854, pp. 1-452.

Zala S. Dual burden of nutrition among adult women in state of Uttar Pradesh: findings from NFHS-4. Indian Journal of Economics and Development, 2018, l6 (7). pp. 1-8.

Zeina M.M., Remancus S., Milner E., Fenlason L., Quick T., et al. Commentary Global mid-upper arm circumference cut-offs for adults: a call to action. Public Health Nutrition, 2020, 23 (17), pp. 3114-3115. https://doi.org/10.1017/S1368980020000385